Student Program Request Form (HA/CA)
Please complete this form at least 2 weeks prior to the event date. A health promotion staff member will respond within 3 business days to confirm the capacity to complete your request.
Your Name *
Your UWO Email *
Your Role *
Required
Your Residence Hall or Organization *
Your RHD/Supervisor or Staff Advisor *
Brief description of the event or program *
Date of Program *
MM
/
DD
/
YYYY
Start Time of Program/Event *
Time
:
Supply Requests *
Required
Approximately how many people do you anticipate attending this program/event? *
Provide any additional relevant information if needed.
Submit
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